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Saturday, July 22, 2017

Physicians are always very skeptical and suspicious that new Health Care Policy is set without vetting of their overall effects on the quality/quantity of outcomes.Elevator and doctor lounge conversation often turns to this subject. It has been several years for the affordable care act to impact some of health outcomes. One study from Yale looked at the effects . of the regulation regarding Hospital Readmission Rates in the first thirty days following discharge from the hospital.Investigators at Yale University ,F. Perry Wilson MD, MSCE compared the incidence of certain events since the new regulation went into effect. He points out how regulations can have unintended consequences.1. Are longer hospital stays reducing readmission rates?2. Do longer stays increase the cost of hospital care ? (Doctors delay discharges to avoid readmission rates)

"I'm showing you the data for heart failure here, but the results were pretty similar for acute MI and pneumonia.Basically, each dot represents a hospital, and you're seeing the relationship between a hospital'schange in readmission rate, and change in 30-day mortality rate.The statistics suggest that hospitals that reduced readmission had a slight reduction in 30-day mortality too,but the signal was pretty small – visible only to statistical software and not the human eye. There were other factors not considered in the study, such as:They did not examine the relationships between length of stay, readmission rate, and mortality, they did examine inpatient mortality in a secondary analysis and again found no increased risk among hospitals with better readmission rates. So even if hospitals are keeping patients longer, it doesn't seem like this is killing them.In this case, we have no evidence of unintended consequences from the HRRP. But this is but one policy of many, and in a health systemas complicated as ours, prediction of the effects of policy will never be a match for measurement of those effects."The results of the study come at an important time as legislators try to determine fixes to the ACA.

Disclaimer

The opinions in this blog or other forms of social media are solely that of Gary M. Levin M.D. Dr. Levin has no financial interests in any medical devices which are discussed or which appear in the blog. Commentary taken from other sources are either quoted or referenced with attribution. Dr Levin does not endorse, nor give financial support to any political organizations.